Provider Demographics
NPI:1457308983
Name:ODACHOWSKI, CYNTHIA MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARY
Last Name:ODACHOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLEAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2513
Mailing Address - Country:US
Mailing Address - Phone:716-652-3127
Mailing Address - Fax:716-652-3128
Practice Address - Street 1:19 OLEAN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2513
Practice Address - Country:US
Practice Address - Phone:716-652-3127
Practice Address - Fax:716-652-3128
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006541-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00623438001OtherBLUE CROSS BLUE SHIELD
NY000623438001OtherCOMMUNITY BLUE
NY9307528OtherIHA
NY00026011901OtherUNIVERA/ SENIOR CHOICE
NY9307528OtherIHA